What can your EMT-B's do??

[Scaramedic]

Hell Cheney's aim is the only thing I like about him. Come on he shot a Lawyer in the face. You can't tell me you haven't wanted to see that at least once.

Johhny Cochran? Gloria Allred? Allan Dershowitz?

[Eydawn]

So what do we do in the meantime, while we're still in the forum discussion stages of this educational change that a lot of us desire? Let EMT-B's use older protocols that don't integrate some of the knowledge that they could?

I for one think CBEMT's idea of a checklist is a great idea... because, even I didn't realize that there were some oral agents that diabetics took that could cause a PROLONGED hypoglycemic episode. For all I've learned about the disease and despite having a parent with Type II, I had absolutely no idea that could happen. Never heard any EMS individual mention it to me, either in class or in the field.

So what are you going to do? Let an EMT-B who's confronted with a superficially easy case operate on that reduced knowledge base and maybe harm the patient?

You can talk about change all you want, but if we are going to do anything about this, we're going to have to develop an interim plan and a way to integrate the providers we've already trained, or we won't be taken seriously. Part of that interim plan has to be better protocols, tailored to the education level we have now, taking into account the lack of pharmacological etc. knowledge that many EMT-B's have.

Part of intelligence and ingenuity involves accurately assessing the resources you've got, estimating the time it will take to change to the system you want, and learning to utilize what you've got now in a better manner until you can get the ball rolling.

So how are we going to do this? How do we convince our educational system that this is what we really want? How do we change the payscale that we'll be receiving once we've all got these shiny degrees? I don't want to hear any more of "this is what needs done," because the majority of people who are going to agree with that position on this forum have already been convinced. I want to hear ideas about HOW. And I'm willing to help... I just need to know what the older and wiser heads think before I jump in prematurely and screw things up.

Wendy

CO EMT-B

[CBEMT]

Neat is not what we're looking for. It's not about appearances. It's not about seeing how well we can get along with everybody, or how the new system makes them "feel." Compromise is completely ineffective. Compromise is why nothing gets done in Washington. Compromise is what is killing the Republican party.

Who said anything about anybody's feelings? What I'm talking about is exactly what Anthony said- making a few improvements to patient care NOW instead of burning up bandwidth talking about what we wish we had that we might reach 20 years from now.

Between here and there, obviously, are a lot of diabetics who we can be doing better for. And that's just one example.

The Canadians didn't compromise.

I think you're the last person who needs a lecture on the differences between the Canadian and American forms of government, and why accomplishments such as their EMS systems are 1000x easier to achieve there instead of here.

[rdenman26]

Over hear basic level ambulance personnel (the NHS one at least) can in addition to the usual BLS, bandageing spinting, O2 etc;

Laryngeal Mask Airway

Basic Ventilatiors

Automated and manual defib of adults and automated defib of paedicatric pts

12 lead ECG

Glucometry

Aspirin

GTN sublingual spray

IM Glucagon, Naloxone, Epi (for anaphylaxis)

Hypostop gel

Entonox (Nitrous Oxide/Oxygen)

Nebulised Salbutamol (albuterol??) and ipratropium

[Dustdevil]

I for one think CBEMT's idea of a checklist is a great idea...

I'd certainly give it credit for being a practical idea. No doubt about that. But it falls far short of greatness. Dumbing down the practice of medicine just remains a pretty stupid idea, no matter how you dress it up.

You can talk about change all you want, but if we are going to do anything about this, we're going to have to develop an interim plan and a way to integrate the providers we've already trained, or we won't be taken seriously.

You can't be serious. Who exactly do you think is going to take us more seriously simply because we refuse to dump dead weight? It's because of those providers we've already "trained" that we are not taken seriously in the first place! It was a marriage made in Hell from the very beginning. What possible good could come from prolonging it?

Part of that interim plan has to be better protocols, tailored to the education level we have now, taking into account the lack of pharmacological etc. knowledge that many EMT-B's have.

Wait... isn't the point of progress to IMPROVE care, not dumb it back down? What kind of respect do you expect to get from that? Why does it "have to be" part of the plan? And why does there have to be an interim plan at all?

Part of intelligence and ingenuity involves accurately assessing the resources you've got, estimating the time it will take to change to the system you want, and learning to utilize what you've got now in a better manner until you can get the ball rolling.

Wrong. Intelligence is the ability to critically assess your situation and cut your losses when you realise it has become completely untenable and irreparable. EMS is a 1973 Ford Pinto that spent its life in Michigan. The entire body and frame are rusted and rotten. The tires are worn. The engine is belching black smoke, and you can already hear a rod beating through the oil pan. Putting new tires and a paint job on this thing is not the answer. It's not even an intelligent "interim plan." It's time to stop throwing good money after bad and prolonging the inevitable. It's time for a new car.

The very best thing we can do for today's EMT-Bs is to open up their schedule to allow them to become a paramedic in the next two years. Unemployment does wonders for your free time.

If everybody insists on keeping low-trained, blue collar labourer jobs in EMS, at least start spending that 120 hours on driving training instead of the pointless first aid course they currently get. That way they can actually be good at something that is useful to me. But they will never, ever be qualified to practise advanced medical care on human beings (or my pets, for that matter) until they get much, much more education than the majority of them will ever be willing to get.

[Eydawn]

I notice you didn't address my request to help us get the ball rolling... If you think we can dump EMT-B's entirely and start from scratch while still being able to provide anything near adequate medical care in America, then show me how it's going to happen.

Also, please show me where the money is going to come from... since we all know EMS is just rolling in loot at the moment... and how creating another unemployment wave will allow anyone to just "go to school" to become a paramedic.

You missed the whole gist of what I was saying, Dust. Didn't you notice that I wanted to change protocols so that they were tailored to the level of education we've got now? I'm not advocating giving basics more skills, I'm advocating winnowing things down so that it's something that actually works with the tools they've got. By creating more specific requirements for things like "treat and street" you're not degrading the level of medical care- you're removing some of that responsibility from providers who through no fault of their own in many cases have not been educated adequately. You're installing some fail-safes.

I'd give you some more credit for this response if I had been advocating permanently keeping our current EMT-B's at the educational and training level they're at. I didn't.

Why does there have to be an interim? Because bureaucracy moves like molasses in January, and if we simply fire all the basics or intermediates currently employed for performing at the level that's been required of them, we're going to look even worse. Things don't happen overnight.

Now, if you really want to see this change, how about addressing the other part of my post? How do you propose we *really* start changing things? What's your plan of attack, oh wise elder? Give us some ideas and let's get it going. The longer we take screwing around complaining about basics, the longer it'll take to change things.

Wendy

CO EMT-B

[firemedic37]

These are the advanced skills EMT-Bs need:

Establish IV (NS, LR, D5)

Dual-Luman Airway (King LTD or Combitube)

Nitro

ASA

Narcan

Albuterol

Glucose Monitering

Acquire 12 Leads

These skills will cut back on the need to have a Paramedic on every Ambulance. They will be able to handle most of the calls we run. I beleive these are the most common treatments and procedures Paramedics provide. My service came up with this list several months ago. Really how many times do you intubate a patient? If you run 10 or more calls a day your chances go up however the King LTD is a great alternative to ETT.

Well thats my 2 cents worth

[JPINFV]

Just wondering, how much education and training do you believe should be added to the EMT-Basic course to make them able to understand the what, when, and when not of your suggested additions to the EMT-Basic treatment and evaluation options? Please consider that the current level of education provided to basics is woefully inadequate, especially in terms of anatomy and physiology.

[VentMedic]

My ideal EMS program would be 2+ years in length.

Just like other profesional healthcare programs, you would have to satisfy the prerequisites prior to applying. This would include at least 1 semester (2 preferably) of A&P, Math and General Chem.

After the prerequisites are met, you could then apply for the 2 year program.

At the end of the 1st year you would be eligible to sit for the EMT-B. If there must be a lesser level than Paramedic then it should at the very least combine some of the intermediate level.

At the end of the 2nd year, you'd be eligible for the EMT-P.

If you stop at EMT-B, you would have 5 years to go back for EMT-P or repeat all the sciences.

There should only be the two levels; no A, advanced B, C, D, or whatever. Eliminate 46 of the 48 different certifications. Period.

Okay, the FireFighters could still have their First Responder cert.

[akroeze]

So what you're suggesting is Ontario's system?

Yes, I'm bad :twisted: